From the Department of Medicine, Renal Transplant Office, New York Medical College, Westchester Medical Center, Valhalla, NY.
Department of Medicine, Stony Brook Teaching Hospital, Stony Brook, NY.
Cardiol Rev. 2020 Nov/Dec;28(6):312-318. doi: 10.1097/CRD.0000000000000304.
Exposure to heavy metals is common. This exposure is related to environmental contamination of air, water and soil, occupational exposure, accumulation in food, tobacco, and other factors. Cadmium and lead are notable for their widespread contamination, long-lasting effects in the body, and renal as well as cardiovascular toxicity. Acute toxicity due to high-level exposure, as well as chronic low-level exposure are now well-established pathogenic entities. Both chronic renal failure and ischemic heart disease patients have been treated separately in recent studies with ethylenediaminetetraacetic acid (EDTA) chelation therapy. In patients with chronic kidney disease (serum creatinine: 1.5-4.0 mg/dL) and increased body lead burden, weekly low-dose chelation with calcium EDTA slowed the rate of decline in renal function in patients with diabetes and in non-diabetic patients. In patients with a history of myocardial infarction, the Trial to Assess Chelation Therapy study showed that EDTA chelation decreased the likelihood of cardiovascular events, particularly in patients with diabetes. However, heavy metal levels were not measured in this study. It is clear that more research is needed in this area. There is also a need to more frequently consider and test for the possibility of cadmium and lead toxicity in patients with increased risk, such as those with hypertension, diabetes mellitus, and chronic renal disease.
重金属暴露很常见。这种暴露与空气、水和土壤的环境污染、职业暴露、食物、烟草和其他因素中的积累有关。镉和铅因其广泛的污染、在体内的持久影响以及对肾脏和心血管的毒性而引人注目。由于高水平暴露引起的急性毒性以及慢性低水平暴露现在已经是明确的发病实体。在最近的研究中，分别对慢性肾衰竭和缺血性心脏病患者进行了用依地酸二钠（EDTA）螯合疗法治疗。在患有慢性肾脏病（血清肌酐：1.5-4.0mg/dL）和体内铅负荷增加的患者中，每周低剂量用钙 EDTA 螯合治疗可减缓糖尿病患者和非糖尿病患者肾功能下降的速度。在有心肌梗死病史的患者中，评估螯合治疗试验表明 EDTA 螯合治疗降低了心血管事件的可能性，特别是在糖尿病患者中。然而，这项研究并未测量重金属水平。显然，在这一领域还需要进行更多的研究。还需要更频繁地考虑和测试具有高血压、糖尿病和慢性肾脏病等较高风险的患者发生镉和铅毒性的可能性，并进行测试。
